Endoscopic Management of Massive Hemorrhage 12 h Post Laparoscopic Roux-en-Y Gastric Bypass

Abstract

Background

Acute (<24 h) staple line bleeding is not common but a known complication after bariatric surgery at a rate of 1–3 %. In most cases, acute postoperative bleeding is mild and can be managed conservatively. Nonetheless, there are times when massive hemorrhage is encountered. Endoscopic treatment of these patients within 24 h of Roux-en-Y (RYGB) is controversial, due to fear of staple line dehiscence and/or perforation. Therefore, most surgeons prefer to undergo diagnostic laparoscopy for exploration and treatment. However, it has been reported that laparoscopic management of acute bleeding can be technically challenging with a high rate of morbidity as well as conversion to laparotomy. We herein present a multimedia video (6 min) demonstrating the management of acute massive hemorrhage after RYGB.

Methods

A 46-year-old female with hemodynamic instability after massive hematemesis and melena underwent endoscopy. An overtube was utilized to allow removal of large blood clots which obstructed endoscopic visualization. Two bleeding points were noted, and these were successfully treated with adrenaline and endoscopic clips.

Results

The patient rapidly improved during her hospital stay and commenced oral intake on day 1. A surveillance endoscopy was performed on day 5, and no stigmata of recent bleeding was noted. She was discharged home and is progressing well.

Conclusions

We suggest endoscopy is an appropriate first step for the investigation and management of acute intraluminal bleeding post bariatric surgery.

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Conflicts of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Informed Consent

Informed consent was obtained from the individual participant included in the study.

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Correspondence to Josemberg M. Campos.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

This video illustrates the endoscopic management of bleeding at the gastrojejunal anastomosis 12 h post Roux-en-Y gastric bypass. It also illustrates the utility of an overtube in removing large blood clots to allow adequate visualization. (MP4 161163 kb)

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Campos, J.M., Moon, R., Teixeira, A. et al. Endoscopic Management of Massive Hemorrhage 12 h Post Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 25, 1981–1983 (2015). https://doi.org/10.1007/s11695-015-1812-6

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Keywords

  • Hematemesis
  • Melena
  • Endoscopic clips
  • Roux-en-Y gastric bypass
  • Gastrointestinal bleeding
  • Anastomotic bleeding
  • Complication